This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tatter, S. B. Articles by Ogilvy, C. S. Search for Related Content PubMed PubMed Citation Articles by Tatter, S. B. Articles by Ogilvy, C. S.

(Stroke. 1995;26:891-895.)
© 1995 American Heart Association, Inc.

Articles

Acute Lacunar Stroke in Association With Angiogram-Negative Subarachnoid Hemorrhage

Mechanistic Implications of Two Cases

Stephen B. Tatter, MD, PhD; Ferdinando S. Buonanno, MD Christopher S. Ogilvy, MD

From the Neurosurgical Service, Cerebrovascular Surgery (S.B.T., C.S.O.), and the Department of Neurology (F.S.B.), Massachusetts General Hospital, Boston.

Correspondence to Christopher S. Ogilvy, MD, Director, Cerebrovascular Surgery, Neurosurgical Service, VBK-710, Massachusetts General Hospital, Boston, MA 02114. E-mail ogilvy@helix.mgh.harvard.edu.

Background and Purpose Although there is much speculation regarding the source of bleeding in patients with subarachnoid hemorrhage when no angiographic abnormality is found, little direct evidence has been obtained to document a cause. We report two cases of stroke in the distribution of a perforating or lenticulostriate artery occurring at the time of angiogram-negative subarachnoid hemorrhage.

Case Descriptions A 68- and a 60-year-old man each presented with acute onset of headache and meningismus. Computed tomography (CT) revealed subarachnoid hemorrhage in a perimesencephalic pattern and in the left sylvian fissure, respectively. In both instances, immediate CT revealed evidence of an early infarction in the distribution of a perforating artery originating at the site of the subarachnoid blood. Both of these strokes were demonstrated to be acute by evolution on serial imaging studies. No source for the subarachnoid blood could be found in either patient in cerebral angiograms repeated at 2 weeks.

Conclusions These observations suggest that in some cases of angiogram-negative subarachnoid hemorrhage the source of blood may be a small artery that is obliterated at the time of hemorrhage. This observation provides an explanation for the low rate of rehemorrhage among patients with angiogram-negative subarachnoid hemorrhage.

Key Words: angiography • arterial occlusive diseases • cerebral arteries • cerebral infarction • subarachnoid hemorrhage

This article has been cited by other articles:

				I. C. van der Schaaf, B. K. Velthuis, A. Gouw, and G. J. E. Rinkel Venous Drainage in Perimesencephalic Hemorrhage Stroke, July 1, 2004; 35(7): 1614 - 1618. [Abstract] [Full Text] [PDF]

				G. Marquardt, T. Niebauer, U. Schick, and R. Lorenz Long term follow up after perimesencephalic subarachnoid haemorrhage J. Neurol. Neurosurg. Psychiatry, July 1, 2000; 69(1): 127 - 130. [Abstract] [Full Text] [PDF]

				W. I. Schievink, E. F.M. Wijdicks, and R. F. Spetzler Diffuse Vasospasm after Pretruncal Nonaneurysmal Subarachnoid Hemorrhage AJNR Am. J. Neuroradiol., March 1, 2000; 21(3): 521 - 523. [Abstract] [Full Text]